Pilocytic Astrocytoma-management of Post Operative Complications

Abstract

Pilocytic astrocytoma (PA) is the most common juvenile cerebellar tumor and glial neoplasm of the central nervous system, typically diagnosed in children and young adults. Characterized by benign, low-grade, slow-growing tumors, PA has a favorable prognosis, with a 94% survival rate at 10 years. Most often located in the cerebellum, these tumors may also present in the optic tracts, hypothalamus, and brainstem. A 5-year-old male with a history of recurrent PA presented with generalized tonic-clonic seizures and acute neurological deterioration, requiring urgent management. He had undergone prior surgery and radiotherapy for a left temporal PA. Upon presentation, the patient was treated with a range of interventions, including antiepileptics, antibiotics, and corticosteroids for cerebral edema, and was supported with ventilatory assistance. A resistant Acinetobacter species was identified in surgical cultures, and targeted antibiotic therapy was adjusted accordingly. Despite ongoing seizures and neurological deficits, gradual improvement was observed, particularly in motor function, with physiotherapy and careful weaning from mechanical ventilation. This case highlights the complex management of recurrent PA, emphasizing the importance of timely surgical interventions, individualized seizure control, targeted antimicrobial therapy, and multidisciplinary rehabilitation in improving long-term outcomes for pediatric patients. Follow-up care, including regular neurology and oncology consultations, is crucial for monitoring tumor recurrence and managing complications.